Identity
Prefer their family’s country of origin to pan-ethnic terms
Most do not have a preference for either term “Hispanic” or “Latino”; when a preference is expressed, “Hispanic” is preferred
Most do not see a shared common culture among US Hispanics
Most do not see themselves fitting into the standard racial categories used by the US Census Bureau
Latinos are split on whether they see themselves as a typical American
American experience
Their group has been at least as successful as other minority groups in the USA
See the USA as better than Latinos’ countries of origin in many ways, but not in all ways.
Most immigrants say they would migrate to the USA again
Language use
Most Hispanics use Spanish, but use of English rises through the generations
Believe learning English is important
Want future US Hispanic generations to speak Spanish
Social and political attitudes
More so then the general public, believe in the efficacy of hard work
Levels of person trust are lower among Latinos than they are among the general public
On some social issues, Latinos hold views similar to the general public (e.g., homosexuality should be accepted), but are more conservative on others (e.g., abortion)
Religion is more important in the lives of immigrant Hispanics than in the lives of US–born Hispanics
Political views are more liberal than those of the general US public
Acculturation is moderated by gender, age, and country of origin. For Hispanics who ascribe to traditional gender roles, it is more likely that males will have contact with non-Hispanic acculturation agents and exhibit faster language acculturation than do Hispanic females. Give the socialization difference among age groups, it would be expected that younger Latinos are more likely to acculturate faster than older Latinos. Puerto Ricans have different language usage compared to other Hispanic groups and prefer the use of English at home, work, and in social occasions (Alvarez, n.d.). Acculturation and assimilation have specific implications for Latino elders, many of whom immigrated to the USA. The immigration process and transition from country of origin to the USA has been difficult for Latino elders because of increased pressure to acculturate and assimilate, as well as how to deal with stress from hardship and poverty and a range of adverse experiences (e.g., stigma, discrimination, trauma, and abuse) (Aguilar-Gaxiola et al. 2012). Alegria et al. (2008) found that a decline in health status of immigrants (more so for Mexicans and less for Puerto Ricans) over time in the USA is associated with higher social acculturation including lifestyle, cultural practices, increased stress, and adoption of new social norms, depression and other mental health disorders, which are discussed later in this chapter.
Some research demonstrates that less acculturated older adults are more likely to experience depressive symptoms. One plausible explanation is that immigrant older adults lack the knowledge about the host culture, which creates multiple challenges in one’s life, ranging from daily hassles (e.g., difficulties in maneuvering everyday activities) to chronic strains (e.g., discrimination). The result may be diminished feelings of self-worth and sense of control, which in turn may lead to elevated symptoms of depression (Chiriboga et al. 2002; Gonzales et al. 2001; Jang and Chiriboga 2010; Kwag et al. 2012). Other research suggests that acculturation may influence the experience of pain. Jimenez et al. (2013) conducted a cross-sectional study to estimate the association between acculturation and the prevalence, intensity, and functional limitations of pain in older Hispanic adults in the USA and found that compared to non-Hispanic whites and English-speaking Hispanics, Spanish-speaking Hispanics had the highest prevalence and intensity of pain. However, the differences were not significant after adjusting for age, sex, years of education, immigration status (US-born vs. non-US-born), and health status (i.e., number of health conditions).
Lokpez (2010) distinguishes acculturated Hispanics as those, for whom English is the dominant language, are born in the USA or have been here for 10 or more years, live in suburban areas, conduct business in English, prefer English media, have similar purchase behaviors as the general market, and observe few or no Hispanic traditions. The transition of first- and later-generation Hispanics requires significant social and cultural adjustments, which are associated with changes in perceived health, mental health functioning, and familial relationships (Archuleta 2012). Kwag et al. (2012) examined the correlation between acculturation, depressive symptoms, and perceived density of neighborhood characteristics in Hispanic older adults and found the impact of acculturation on depressive symptoms to be moderated by the perceived density of Hispanic neighborhoods. The researchers concluded that neighborhood characteristics are important in the lives of immigrant older adults.
Acculturation is not unidirectional, thus drawing any conclusion about its impact is complex. In a review of the literature on acculturation and Latino health in the USA and its sociopolitical context, Laea et al. (2005) concluded that “the effects of acculturation, or more accurately, assimilation to mainstream U.S. culture on Latino behaviors and health outcomes is very complex and not well understood” (p. 374). Even with the identification of certain positive or negative trends in the subject areas reviewed about Latino acculturation, the effects are not always in the same direction and often times are mixed. The results were influenced by the subject area, measure of acculturation used, and factors such as age, gender, or other measured or unmeasured constructs. Nevertheless, acculturation is associated with several negative health-related behaviors and health outcomes in Latinos : (a) illicit drug use, (b) drinking, (c) smoking, (d) poor nutrition and diets, and (e) worse birth and perinatal outcomes (e.g., low birth weight, prematurity) as well as undesirable prenatal and postnatal behaviors (e.g., substance use during pregnancy). On the positive side, acculturation is associated with improved access to care and use of preventive health services among Latinos (Laea et al. 2005). In an examination of the role of acculturation in health behaviors of older Mexican Americans, similar results were found by Masel et al. (2006), who found that those who were proficient in English were more likely to have a history of smoking and drinking. Masel et al. concluded that this knowledge can assist health promotion programs in identifying those at-risk of engaging in negative health behaviors. The reader is referred to Laea et al. for additional information.
Hispanic Perspective Regarding LGBT Persons
Bendixen & Amandi International (2010) suggest that it is best to start from a point of shared values to understand and effectively relate to Latinos /Latinas about LGBT issues: family, respect, faith, and opposition to discrimination. Hispanics have been portrayed as particularly anti-gay and more anti-legal gay marriage than other segments of American society (Dutwin 2012). As with any population, there are varying degrees of tolerance. In fact, different from the general population, Hispanics are slightly more likely to support legal gay marriage and be open more generally toward lesbians and gay men in society (Bendixen & Amandi International 2010; Dutwin). Dutwin found that one concern with LGBT acceptance in the Hispanic community is at the “intersection of Hispanicity and religion” (p. 5). The most traditional (i.e., unacculturated) religious Latinos are the most intolerant. However, as Hispanics reside longer in the USA, the more interaction they have with other segments of society, which may potentially increase their exposure to LGBT issues and contact with LGBT persons. Thus, Dutwin hypothesizes that because generations correlate with acculturation and future generations are far more likely to comingle and be acculturated than earlier ones, over time, Hispanics will become more tolerant.
In the Pew Hispanic Center Survey (2012), 52 % of Latinos favored same-sex marriage compared to 34 % who opposed it. When asked whether sexual minorities (the term homosexuality is used in the survey) should be accepted or discouraged by society, a majority of Latinos (59 %) and 58 % of the US general population say homosexuality should be accepted, as compared to 30 and 33 %, respectfully, say it should be discouraged. Views on homosexuality vary by immigrant generation. Second-generation Hispanics (68 % vs. 24 %) and third-generation Hispanics (63 % vs. 32 %) are generally in favor of acceptance. Females (62 %) more than males (55 %) support acceptance, and younger (18- to 29-year-olds, 69 %) and middle-aged (30- to 49-year-olds, 60 %) more than older (age 50–64, 54 %, 65+, 41 %) (Taylor et al. 2012). These findings are consistent with those of an earlier poll conducted by Bendixen & Amandi International (2010), which found Latinos are broadly supportive of equality for gay people (Table 10.2).
Table 10.2
Latino support equality for gay people
80 % believe that gay people often face discrimination |
83 % support housing and employment non-discrimination protections for gay people |
74 % support either marriage or marriage-like legal recognition for gay and lesbian couples |
73 % sat that gay people should be allow to serve openly in the military |
75 % support school policies to prevent harassment and bullying of students who are gay or perceived to be gay |
55 % (and 68 % of Latino Catholics) say that being gay is morally acceptable |
The attitude of people toward LGBT persons is shaped, in part, by the degree to which they believe sexuality is innate, shaped by upbringing, or a matter of personal preference. In 2011, a Gallup Poll found that 42 % of Americans believe that homosexuality is due to upbringing or environment, and 40 % believe people are born homosexual. In a survey of Latinos beliefs toward lesbians and gay men, Dutwin (2012) found that 62 % believe homosexuality is due to biology, and 20 % to personal preference. Not surprisingly, non-religious Latinos are most likely to believe that homosexuality is biological, followed closely by Catholics compared with those who go to church, who are substantially less likely to believe that homosexuality is something with which people are born. In fact, Latinos who do not go to church at all or go infrequently are twice as likely to believe that homosexuality is biological compared to Latinos who go to church twice per week.
Research documents that LGBT persons experience a high degree of discrimination. In response to questions about beliefs of the discrimination they experience in the USA relative to other minority groups, Latinos generally believe that Latinos and gays and lesbians are discriminated against to a greater degree than are African Americans and women. Furthermore, Latinos believe that, of all minority groups, gays and lesbians experience the most discrimination (Dutwin 2012). These beliefs are linked to Latinos’, especially younger Latinos, views of fairness and social justice.
A Statistical Profile of Latino Elders
The Latino population is younger than any other racial or ethnic group in the USA; thus, a small proportion of the Latino population is aged 65 and older (i.e., 7 % or 3 million) (US Census Bureau 2010a). Approximately two of three Latinos aged 65 and older live in one of four states: California, Texas, Florida, or New York. The Latino elderly population disproportionately lives in poverty. Foreign-born Latinos elders are more likely to live in poverty than native-born Latinos. Latinos born outside the USA may be less likely to speak English, have lower levels of education, and have less access to Social Security benefits than their native counterparts (Pew Hispanic Center 2010). The median annual income for households headed by a Latino adult aged 65 and older is $22,116, compared with $29,744 for all households headed by someone aged 65 or older and $31,162 for households headed by non-Latino whites in the same age range (Bureau of labor Statistics & US Census Bureau 2009).
Latino elders have a different source of income than older adults from other racial and ethnic groups with higher income levels. The greatest source of income is from Social Security income (82 %), property (27 %), earned money from wages, salary, or self-employment (20 %) and pension (17 %). In contrast, non-Latino whites aged 65 and older have greatest income sources that include Social Security income (90 %), property (61 %), pension (33 %), and earned money (21 %) (Bureau of labor Statistics & US Census Bureau 2009). Although fewer Latino elders receive Social Security benefits, Social Security income is more important and provides at least half of their total income (National Committee to Preserve Social Security and Medicare 2008). Latinos receive Social Security at lower rates because they are less likely to have paid into the system for enough years to become eligible to receive benefits, are immigrant workers without the appropriate legal status to receive coverage, or work in the type of jobs (e.g., domestic and agricultural) in which employers tend to underreport Social Security earnings (Torres-Gil et al. 2005). The extent to which these data are applicable to LGBT Latino elders is not known.
Older Hispanic adults are vulnerable to the stresses of immigration and acculturation (National Council of La Raza 2005). Health status differs across national-origin groups. In addition, the health of US Hispanics differs by generational status. Among foreign-born Hispanics, health status and health behaviors may differ by degree of acculturation to American culture. The two leading causes of death are heart disease and cancer among Hispanics, with homicide responsible for the higher death rate among Hispanic men aged 15–24 (Tienda and Mitchell 2006). While Latinos use mental health services less than the general population, rates of usage have increased. However, bilingual patients are evaluated differently when interviewed in English as opposed to Spanish and Hispanics, who are more frequently undertreated (American Psychiatric Association 2014). Health and health behaviors of Hispanic adults are discussed in detailed later in this chapter.
Latino/LGBT Older Adults
With the growing number of Hispanic LGBT elders , a tremendous need exists for community-based organizations that serve them in a culturally and linguistically competent manner. As they age, many LGBT Hispanic elders feel excluded and isolated. Exclusion and isolation is compounded by societal prejudice and discrimination, they are as members of both a sexual minority and ethnically marginalized group. Furthermore, LGBT Hispanic elders may become estranged from family members who condemn their sexualities on religious grounds or who lack understanding. Similarly, they may experience alienation from their faith community, depending on the community’s stance toward LGBT persons (National Hispanic Council on Aging 2013). An analysis of qualitative data from focus group discussions of LGBT Hispanic older adults revealed some of the following comments: (a) acceptance of LGBT persons is very difficult among Latinos because of our nature (i.e., culture); (b) family is the most important nucleus in society from which we receive understanding, love, and affections and if we do not receive that, other factors happen, such as depression or suicide; and (c) there are people who are 90 years old and have never said they are gay, they are bearing the cross because their family cannot accept that (National Hispanic Council on Aging 2013).
LGBT Hispanic elders face many of the same challenges as do older adults in the general population, such as accessing community services and benefitting fully from Medicare, Medicaid, and Social Security. However, their challenges in these areas are more difficult because of the marriage inequity for same-sex couples, which adversely affects retirement benefits and health insurance (National Hispanic Council on Aging 2013). Research on LGBT Hispanic elders is limited and based on the information from those individuals willing to acknowledge their identities and relationships. The ability of researchers to identity, recruit, and maintain contact with LGBT Hispanic elder participants for research is limited by their mistrust of unfamiliar institutions, cultural and linguistic barriers, lack of transportation, limited formal education, financial constraints, negative stigma associated with mental health problems, and lack of understanding of the purpose of the research and how it will benefit the community (Alvarez et al. 2014; Kuhns et al. 2008). In addition, transgender Hispanics tend to be excluded because of their unwillingness to self-identify or come out. Much of the information in this section consists on an overreliance on data from the Hispanic LGBT Older Adult Needs Assessment (National Hispanic Council on Aging 2013).
The economic status of LGBT Hispanic elders is similar to that of their non-LGBT counterparts. Hispanic male same-sex households have an average annual income of $49,800; female same-sex couples have an average yearly income of $43,000, compared to Hispanic married opposite-sex household earning $44,000 on average (Cianciotto, 2005). The lower level of economic security and being disadvantaged in the job market has implications for housing and home ownership of LGBT Latino elders . Many LGBT Hispanic elders who qualify for Section 8 housing are unable to receive it because they lack immigration status documentation of Social Security registration (National Hispanic Council on Aging 2013). Many LGBT Hispanic elders are living below the federal poverty level with insufficient funds to cover their basic living expenses. Before the US Supreme Court decision to strike down Section 3 of the Defense of Marriage Act (DOMA), which discriminated against the economic security of LGBT persons across the country, LGBT seniors of a single-income household could not claim the retirement, Social Security, or survival benefits of a deceased partner. However, the invalidation of Section 3 of DOMA only applies in states that recognize the equality of same-sex marriage.
Aging is a difficult experience in the LGBT Hispanic older community. Many LGBT Latino elders feel that, unlike Latino culture, LGBT elders are marginalized and forgotten as they age in a LGBT community that values youth and physical attractiveness. LGBT Hispanic elders feel that aging in the LGBT community is associated with loneliness, illness, and loss of economic opportunities because of being unable to advance professionally or compete in the job market, particularly for those without support of their families and do not have children to take care of them. Isolation is heightened because of the limited number of gathering places for older LGBT persons to socialize, in contrast to the number of programs and center for LGBT youth and senior centers for the elderly Spanish-speaking community. The significance of this becomes evident for LGBT elders who are rejected by their families for their sexual orientation or sexual identity (National Hispanic Council on Aging 2013).
The health status of LGBT Hispanic elders is further compromised because they are uncomfortable with sharing their sexuality with their provider. The situation is magnified for transgender Latino elders who are frequently diagnosed in advance stages of sexually transmitted diseases because they never got tested. Medical providers only pay attention to the presenting problem and do not ask or check other problems. LGBT Hispanic elders indicate that most doctors lack education about the LGBT community, are homophobic/heterosexist, and are unaware of their own insensitivity. These factors, coupled with doctors who do not speak Spanish or train in centers in Hispanic communities, further impede LGBT Hispanic elders’ access to and utilization of services and may have detrimental effects on this population’s health (National Hispanic Council on Aging 2013).
Social and Health Inequities of Latino and LGBT Latino Elders
Health inequities among LGBT populations of color are largely a product of unaffordable health insurance, lack of cultural competencies among healthcare providers, and prejudice about race and ethnicity (Krehely 2009). Hispanic elders have health disparities and face numerous challenges to accessing social programs and healthcare services. Adults in Latino families are more likely to be primary caregivers for elders in the home setting for extended periods of time, and without supports from professional community services, than are adults in non-Latino white families (Koerner et al. 2013). Of 65 million Americans who provide unpaid care to an adult, Hispanic households have the highest prevalence of unpaid family caregivers (National Alliance for Caregiving and AARP 2009).
Hispanic elders have a relatively high prevalence of diabetes, and 56 % of Hispanics aged more than 50 have at least one chronic health condition (National Healthcare Disparities Report 2005). Compared to non-Hispanic whites, Hispanics have higher rates of Type 2 diabetes and other manifestations of abnormal glucose metabolism. For Hispanics aged 45–74, 23.9 % of Mexican origin 15.8 % of Cuban origin, and 26.1 % of Puerto Rican origin have diabetes (Tienda and Mitchell 2006). Other prevalent health conditions include Alzheimer’s disease, depression, and fatal falls. According to the National Healthcare Disparities Report, compared to the majority non-Hispanic white, elderly population, Hispanic elders have the following prominent disparities. They are less likely to: (a) achieve diabetes control (e.g., more likely to be hospitalized for diabetes), (b) receive vaccinations for pneumonia or influenza, (c) receive recommended hospital care for pneumonia, (d) receive cancer screening services, (e) have an ongoing source of care, and (f) receive counseling to increase physical activity, if overweight. In addition, Hispanic elders are more likely to fall multiple times in one year (Wallace 2006) and are less likely to receive preventive care.
Hispanic adults have lower rates of hypertension than non-Hispanic whites but are less likely to have their blood pressure controlled. Few data are available on heart disease among Hispanics; data on the incidence and prevalence of stroke are also scarce. The utility of existing data is limited because of issues of generalizability. Rates of obesity have increased among Hispanics and are higher than for non-Hispanic whites (Tienda and Mitchell 2006). Acculturated or US-born Hispanics have higher rates of obesity than immigrant counterparts because of a higher consumption of fatty foods. Park et al. (2003) found that Hispanics of Mexican origin have the highest age-adjusted prevalence of metabolic syndrome (abdominal obesity) of any racial or ethnic group. Moreover, Mexican-origin women are more likely than non-Hispanic white or black women to have metabolic syndrome, even after controlling for predisposing factors such as body mass index, alcohol consumption, physical activity, and carbohydrate intake.
Cultural (e.g., linguistic), socioeconomic (e.g., education, occupation, income), and geographical (e.g., rural) (Erving 2007) lack of awareness about services, and stigma associated with mental illness (American Psychiatric Association 2014) are barriers to health care and are main predictors of health outcomes. Bohorquez contends that while Hispanic elders share some behaviors with non-Hispanics, many traits are unique to Hispanic seniors, which dictates the marketing and promoting of healthcare products and services to Hispanic elders. These include knowledge, access, language, education, and culture. Hispanic elders have a desire for healthy living and behavioral changes but are less aware and knowledgeable of steps to take than the general senior population. Although Hispanic elders have less access to a regular physician or insurance compared to the general population, the magnitude of access as a barrier is less than expected. The issue is that they are less likely to use services provided by healthcare professionals. This reluctance to use healthcare services may be linked to a language barrier, which makes access a daunting task and an unpleasant experience. Low educational level is related more to existing Hispanic elders than baby boomers, who are more educated and have higher earning power as they attain higher education (Bohorquez). In addition, many Latinos elders have an external locus of control related to health barrier perceptions (Valentine et al. 2008).
Bohorquez’s (2009) cultural manifestations that serve as barriers to Hispanic elders receiving timely and appropriate health care include practices include interdependence, reactivity, home remedies, fear, and marianismo/machismo. In fact, Bohorquez considers culture to be “the most invisible yet powerful barrier” (p. 52). The cultural manifestations interdependence of Latino culture are not a barrier, but are introduced here as one cultural manifestation. Cultural interdependence is evident by the living arrangements of Latino elders as members of an extended household. In fact, the number of Latino elders living alone is almost half that of the general population. The family acts as a motivator for elders for maintaining good health and to be self-sufficient and to contribute to the family (Bohorquez).
The use of home remedies or natural supplements to treat illness as an alternative to Western health care is commonplace among Latinos. In some ways, the use of home remedies is linked to spirituality, and in other ways, it is linked to financial constraints, distrust of Western medicine, and lack of knowledge or awareness about health issues. Hispanics generally lack a preventive mind-set. They are more concerned about current needs as opposed to future ones. Even those with healthcare coverage will typically visit a doctor only when they are very ill. This reactive mind-set prevents detection of illness that could be treated at an earlier stage. The belief is that whatever happens is “Si Dios quiere” (“It is God’s Will”) (Bohorquez). Many Hispanic elders may feel that their health may be out of their control and in the hands of a “higher being,” resulting in a fatalistic viewpoint (fatalism) toward their health condition (Desai et al. 2010). It is important for healthcare providers to recognize that Hispanic elders are more likely to take the advice of respected community members than the advice of their physicians. Other cultural beliefs and practices that affect Hispanic elders’ response to healthcare intervention are presented in Table 10.3.
Table 10.3
Cultural beliefs and practices affecting health care of Hispanic elders
Espiritismo—the belief in the existence of malevolent spiritual beings who may be able to negatively or positively influence the health of material beings |
Prresentismo—the belief that only issues that are immediate problems should be dealt with—a belief that may cause some patients to delay seeking treatment until after complications develop |
Jerarquismo—the interplay of family members in the social structure of Hispanic culture, which is predominantly a patriarchal society |
Promotores—the use of trained lay persons to assist navigating the complexities of the healthcare arena |
Fear is a factor that results in increased poor health status of Latino elders. Both thinking about and talking about the future health needs are seen as emotionally frightening and impractical. In part, the fear is an outcome of Latinos waiting for an illness to advance before seeking health care. As a result, their health is too poor to yield a positive outcome, consequently healthcare providers are associated with severe illness and death. Fear is also a reaction to not wanting to burden their families with healthcare costs. Finally, the ability of women (marianismo) to be successful as mother/nurturers and men (machismo) as fathers/providers does not meet these standards, and Latino elders feel diminished as individuals (Bohorquez). As a result of trying to live up to these gender role expectations, especially in light of being LGBT, Latino elders may experience depression.
Hispanic lesbians and bisexual women are at heightened risk or health disparities compared with Hispanic heterosexual women and non-Hispanic white bisexual women. Kim and Fredriksen-Goldsen (2012) suggest that although sexual minority women are at increased risk for poor health and, within-group differences among sexual minority women exist, evidence of health disparities by race/ethnicity and sexual orientation tends not to generalize to sexual minorities of color. Furthermore, the consequences of multiple stressors such as racial discrimination within sexual minority communities and anti-LGBT values within Hispanic communities may lead to an increased risk of poor physical health and mental well-being (Diaz et al. 2006; Harper et al. 2004). Kim and Fredriksen-Goldsen (2012) found that Hispanic bisexual women are more likely to experience frequent mental distress than are both non-Hispanic white bisexual women and Hispanic heterosexual women. The cumulative risk related to multiple marginalized statuses appears to lead to greater mental distress.
Research Box 10.1: Hispanic Lesbian and Bisexual Women Health Disparities
Kim, H. J., & Fredriksen-Goldsen, K. I. (2012). Hispanic lesbians and bisexual women at heightened risk or health disparities. American Journal of Public Health, 102(1), e9–e15.
Objective: This study investigated whether elevated risks of health disparities exist in Hispanic lesbians and bisexual women aged 18 years and older compared with non-Hispanic white lesbians and bisexual women and Hispanic heterosexual women.
Methods: Population-based data from Washington State Behavioral Risk Factor Surveillance System (2003–2009) were analyzed using adjusted logistic regression.
Results: Hispanic lesbians and bisexual women, compare with Hispanic heterosexual women, were at elevated risk for disparities in smoking, asthma, and disability. Hispanic bisexual women also showed higher odds of arthritis, acute drinking, poor general health, and frequent mental distress compared with Hispanic heterosexual women. In addition, Hispanic bisexual women were more likely to report frequent mental distress than were non-Hispanic white bisexual women. Hispanic lesbians were more likely to report asthma than were non-Hispanic white lesbians.
Conclusions: The elevated risk of health disparities in Hispanic lesbians and bisexual women is primarily associated with sexual orientation. Yet, the elevated prevalence of mental distress for Hispanic bisexual women and asthma for Hispanic lesbians appears to result from the cumulative risk of doubly disadvantaged statuses. Research is needed to address unique health concerns of diverse lesbians and bisexual women.
Questions
1.
If given the opportunity, what types of qualitative would you ask of the Hispanic lesbians and bisexual participants?
2.
What are the major limitations of this study?
3.
Lesbians and bisexual Hispanic women in this study did not show cumulative risks in most other health indicators. What are some possible explanations?
Social support among sexual minorities is an important predictor of mental health. Given that bisexual women report stigmatization and exclusion within gay and lesbian communities, which result in distancing themselves from these communities (McLean 2008), Hispanic bisexual women likely have relatively less social support available to them than do lesbians (Herek 2002). According to Acosta (2008), Hispanic lesbians are able to construct safe environments in which they can share the challenges of being both an ethnic and sexual minority; however, bisexual Hispanic women tend to have fewer such opportunities because of a lack of social support.
LGBT Latinos are affected disproportionately by certain health issues such as mental illness, substance abuse, and addictive disorders, and HIV (especially gay men) (Cochran et al. 2007; Krehely 2009) and have the poorest self-reported status of mental health (Fredriksen-Goldsen et al. 2011). Lesbian Latinas are more likely to experience depression, and gay and bisexual Hispanics are more likely to have attempted suicide than heterosexual Hispanics (Cochran et al. 2007). Depression is prevalent among the Latino elderly population. Several studies suggest a rate between 4 and 44 % of older Latinos experience depressive symptoms, with prevalence varying by country of origin (Alvarez et al. 2014). For example, depressive symptoms for Mexicans in the USA range between 4 and 28 % (Hernandez et al. 2013) and Puerto Ricans between 17 and 44 % (Yang et al. 2008). This wide variance is attributed to how depression is defined (e.g., clinical syndrome vs. cluster of symptoms), type of measure used, whether responses were given in Spanish (or indigenous language such Quechua, Mixteco, or Triqui) or English, validity and reliability of the measure with this population, and culturally determined concepts of illness (Alvarez et al.).
Related posts:
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The Intersection of Identities of LGBT Elders: Race, Age, Sexuality, and Care Network
American Indian, Alaska Native, and Canadian Aboriginal Two-Spirit/LGBT Elderly
End-of-Life Issues for LGBT Elders
Disabilities and Chronic Illness Among LGBT Elders: Responses of Medicine, Public Health, Rehabilitation, and Social Work
LGBT Elders in Nursing Homes, Long-Term Care Facilities, and Residential Communities
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